Personality, emotions and coping styles: predictive value for the evolution of cancer patients

Neuroticism as a moderator of symptom-related distress and depression in 4 noncancer end-of-life populations

OBJECTIVES

Neuroticism is a significant predictor of adverse psychological outcomes in patients with cancer. Less is known about how this relationship manifests in those with noncancer illness at the end-of-life (EOL). The objective of this study was to examine the impact of neuroticism as a moderator of physical symptoms and development of depression in patients with amyotrophic lateral sclerosis (ALS), chronic obstructive pulmonary disease (COPD), end-stage renal disease (ESRD), and frailty in the last 6 months of life.

METHODS

We met this objective using secondary data collected in the Dignity and Distress across End-of-Life Populations study. The data included N = 404 patients with ALS (N = 101), COPD (N = 100), ESRD (N = 101), and frailty (N = 102) in the estimated last 6 months of life, with a range of illness-related symptoms, assessed longitudinally at 2 time points. We examined neuroticism as a moderator of illness-related symptoms at Time 1 (∼6 months before death) and depression at Time 2 (∼3 months before death) using ordinary least squares regression.

RESULTS

Results revealed that neuroticism significantly moderated the relationship between the following symptoms and depression measured 3 months later: drowsiness, fatigue, shortness of breath, wellbeing (ALS); drowsiness, trouble sleeping, will to live, activity (COPD); constipation (ESRD); and weakness and will to live (frailty).

SIGNIFICANCE OF RESULTS

These findings suggest that neuroticism represents a vulnerability factor that either attenuates or amplifies the relationship of specific illness and depressive symptoms in these noncancer illness groups at the EOL. Identifying those high in neuroticism may provide insight into patient populations that require special care at the EOL.

Development and psychometric properties of the Stressors in Breast Cancer Scale

Background

A diagnosis of breast cancer generates psychological stress, due not only to treatment and its side effects but also to the impact on different areas of the patient’s daily life. Although there are instruments for measuring psychological stress in the cancer context, there is currently no tool for assessing stressors specific to breast cancer.

Aims

The aim of this study was to develop the Stressors in Breast Cancer Scale (SBCS).

Method

A panel of experts evaluated the clarity and relevance of scale items, providing validity evidence based on test content. Psychometric properties of the scale were then analyzed.

Results

Validity evidence based on the internal structure of the SBCS was obtained through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), following a cross-validation strategy. The CFA supported a second-order factor model with five dimensions: physical appearance and sex strains, health and daily difficulties, interpersonal relationship strains, healthcare strains, and worries and concerns about the future. This structure was invariant across two groups distinguished by time from cancer diagnosis (less than 3 and 3 years or more from diagnosis). Reliability, based on McDonald’s omega and Cronbach’s alpha coefficients, ranged from 0.83 to 0.89 for factor scores, and reached 0.95 for total scores. Validity evidence was also provided by correlations with depression, anxiety, perceived stress, and perceived health and quality of life.

Discussion

The results support the use of the SBCS for measuring stress as a stimulus in the breast cancer context. Implications for clinical practice and research are discussed.

Psychometric properties of the perceived stress scale (pss-10) with breast cancer patients

Breast cancer diagnosis is one of the most difficult events that a woman can experience during her life and it usually produces high levels of stress. Global measures of perceived stress are useful for screening and for comparing stress levels between cancer patients and other clinical and nonclinical populations. One such instrument that is widely used is the Perceived Stress Scale (pss-10), but its psychometric properties have scarcely been analysed with breast cancer patients. The aim of this study was to provide validity evidence regarding the use of the 10-item version of the pss-10 as a tool for measuring perceived stress in this context. Participants were 215 Spanish breast cancer patients who completed the PSS-10 and the DASS-21, a measure of affective distress (depression, anxiety, and stress). The internal structure of the PSS-10 was examined through confirmatory factor analysis (CFA), and the reliability of test scores was estimated using McDonald's omega coefficient. Validity evidence based on relationships with other variables was also obtained using correlation analysis. The CFA supported a correlated two-factor structure: perceived helplessness (six negatively worded items) and perceived self-efficacy (four positively worded items). Reliability coefficients for scores on these two factors were 0.87 and 0.73, respectively. Scores on affective distress (DASS-21) were strongly and positively correlated with perceived helplessness and moderately and negatively correlated with perceived self-efficacy. The PSS-10 is an adequate tool for measuring perceived stress in the breast cancer context and it may be useful for identifying women at risk of psychological maladjustment.

Life Satisfaction and Character Strengths in Women With Breast Cancer: Zest and Hope as Predictors

BACKGROUND

Empirical evidence shows that life satisfaction is positively related to character strengths, and although this association has been observed in different populations, it is scarce in breast cancer patients. This study analyzes the relationship between character strengths and life satisfaction in Spanish women diagnosed with breast cancer.

METHODS

A sample of 117 women completed the Satisfaction with Life Scale (SWLS) and the Spanish version of the VIA Inventory of Strengths (VIA-IS). Correlation analysis and regression modeling were performed to determine which strengths predict life satisfaction.

RESULTS

The results of the correlation analysis showed that 15 strengths were positively and significantly associated with life satisfaction, with the highest correlations corresponding to zest, hope, curiosity, social intelligence, love, gratitude, and judgment. Regression modeling indicated that of these, zest and hope were key strengths for predicting life satisfaction.

CONCLUSIONS

These findings suggest that intervention programs based on the development of zest and hope could help to improve life satisfaction and, therefore, the psychological well-being of women with breast cancer.

The role of personality traits in participation in an Online Cancer Community

Purpose

The purpose of this study was to investigate how personality traits influence participative behaviour in an Online Cancer Community (OCC).

Design/methodology/approach

Qualitative semi-structured interviews were conducted with 42 users of one of the largest OCCs in Australia – Cancer Council Online Community in New South Wales (NSW).

Findings

The results showed that extraversion, emotional stability and agreeableness traits influence posting behaviour, whereas the conscientiousness trait influences lurking behaviour. The openness trait did not affect either posters or lurkers’ online behaviour.

Research limitations/implications

The research highlights the pivotal role of personality traits in users’ decisions to post or lurk using a multi-theory perspective that combined the social exchange theory and the Five-Factor Model. Future studies should explore personality traits that can benefit from online participation in an OCC to transition only lurkers who may benefit from posting.

Practical implications

Insights from the study inform OCC practitioners and moderators when designing the OCC platform. Except for the openness trait, lurkers and posters exhibited different attitudes, which indicates that integrating these findings in the OCC design can facilitate adopting strategies to elicit more participation by OCC users.

Originality/value

This is the first study that explored the role of personality traits in users’ decisions to participate in an OCC.

Type D Personality and Big Five Personality Traits and the Risk of Breast Cancer: A Case-Control Study

OBJECTIVE

The goal of this study is to establish the differences in Type D personality and Big five personality traits between a group of newly diagnosed breast cancer patients and a group of controls.

METHODS

A comparative study of breast cancer patients and women without previous history of cancer was carried out. We used Type D Scale-14 as an instrument for the assessment of the type-D personality pattern and NEO-FFI for the assessment of the Big Five personality traits. Conditional logistic regression models were used to estimate odds ratios and 95% confidence intervals were applied for breast cancer by personality trait factors.

RESULTS

Negative affectivity (NA) (OR = 4.45 95% CI: 1.96-10.61), neuroticism HIGH (OR = 3.97, 95% CI: 1.08-15.81), openness to experience HIGH (OR = 3.47 95% CI: 1.11-11.49), were associated factors significantly related to an increased risk of breast cancer, whereas Social Inhibition (SI) was associated factor with a decreased risk of breast cancer (OR = 0.40 95% CI: 0.16-0.92).

CONCLUSIONS

This was the first case-control study which analyzed NA and SI traits in breast cancer patients. SI as a breast-cancer risk decreasing factor might indicate that expressing negative emotions is not always a healthy mechanism of their regulation.

The Satisfaction with Life Scale in breast cancer patients: Psychometric properties

Background/Objective

This study aims to analyze the psychometric properties of the Satisfaction with Life Scale (SWLS), examining the reliability of scale scores and providing validity evidence for its use with breast cancer patients. We provide validity evidence based on internal structure and on relationships with positive psychological variables and other variables indicative of psychological adjustment.

Method

Participants were 222 Spanish women with a diagnosis of breast cancer. They completed the SWLS and a battery of questionnaires measuring positive and negative affect, self-esteem, resilience, emotional intelligence, flourishing, optimism, depression, anxiety, and stress.

Results

Confirmatory factor analysis supported a single-factor structure for the SWLS, S-B χ²(5) = 7.36, p = .19, CFI = .99, NNFI = .99, RMSEA = .046. The reliability of test scores estimated with McDonald's omega yielded a value of .80. Validity evidence was provided by a positive correlation between SWLS scores and positive affect, self-esteem, resilience, emotional intelligence (specifically, clarity and repair), flourishing, and optimism (range: .24, .69), and by a negative correlation with negative affect, pessimism, depression, anxiety, and stress (range: -.25, -.59).

Conclusions

The Spanish version of the SWLS showed satisfactory psychometric properties and it is an appropriate measure for use in the breast cancer context.

Cross-Cultural Adaptation and Validation of the Emotional Inhibition Scale in a Chinese Cancer Sample

The Emotional Inhibition Scale (EIS) is a brief measure based on a four-factor model with documented validity in a mood disorder sample that may be useful for assessing emotional inhibition in patient populations, such as individuals with cancer. The present study adapted the EIS to Chinese conditions and examined the psychometric characteristics of the EIS in patients with cancer. The recruited participants comprised a sample of 100 patients (sample 1) and a sample of 202 patients (sample 2) with cancer. The two samples (sample 1 and sample 2) with cancer completed surveys including the EIS. The Toronto Alexithymia Scale-20 was completed by the two sample groups to assess criterion validity. Statistical analyses included internal consistency (sample 1), exploratory factor analyses (EFAs; sample 1), and confirmatory factor analyses (CFAs; sample 2). The results showed that EFA and CFA confirmed the four-factor solution proposed by the original authors (verbal inhibition, self-control, disguise of feelings, and timidity). The internal consistency and test-retest reliability of the EIS were satisfactory. In conclusion, the EIS demonstrated acceptable reliability and validity for assessing emotional inhibition in Chinese-speaking patients with cancer and may be a useful measure for assessing the level of emotional inhibition and the effect of emotional disclosure interventions.

Analysis of Personality Traits in Patients with Hodgkin Lymphoma

Hodgkin lymphoma (HL) is a highly-curable malignancy mostly affecting young people. As far as we know, there is no published study that has analyzed personality profiles in HL nor their potential role in lymphomagenesis, natural history, or response to treatment. We aim to explore the personality traits of HL patients, as well as the prevalence of mental disorders and suicide ideas. We retrospectively identified all alive HL patients from three centers (Son Espases and Son Llatzer University Hospitals and Hospital del Mar of Barcelona) for using NEO Five-Factor Inventory (NEO-FFI) and Personality Inventory for DSM-5 Brief Form. Patients with HL showed significantly higher neuroticism scores and lower conscientiousness, extraversion, and openness. Considering maladaptive personality traits, HL patients showed higher levels of detachment and psychoticism. All of these translated into the fact that HL patients showed more than double the prevalence of mental illnesses (41%) and more than triple the prevalence of suicidal ideation or attempts than the general population (15 and 6%, respectively). An exploratory analysis of biomarkers associated with HL personality traits showed that higher scores of neuroticism correlated with more elevated erythrocyte sedimentation rate (ESR) and red cell distribution width (RDW), suggesting a potential link between neuroticism and proinflammatory activity in HL.

Personality Profiles and Psychological Adjustment in Breast Cancer Patients

Dispositional personality characteristics may play a role in psychosocial adjustment to any disease, including cancer.

PURPOSE

The purpose of this study is to identify personality profiles in breast cancer patients and to determine whether these profiles are associated with psychological adjustment or psychopathology.

METHODS

Participants were 109 women (mean age, 52.01) diagnosed with breast cancer. They completed the Millon Clinical Multiaxial Inventory-III (MCMI-III), the Life Orientation Test-Revised (LOT-R), the Satisfaction with Life Scale, and the Positive and Negative Affect Scales.

RESULTS

The analysis revealed two different personality profiles: (a) one group, comprising 38.23% of the sample, was characterized by paranoid, negativistic, and dependent personality traits and was considered as a "vulnerable group"; and (b) another group (61.77%) was characterized by compulsive, histrionic, and narcissistic personality traits and was considered as a "psychologically adjusted group". The vulnerable group scored higher than the psychologically adjusted group on all clinical syndromes, with scores above 60 on the anxiety, somatoform, dysthymic, and bipolar scales (score on anxiety being above 75); in contrast, the psychologically adjusted group did not reach a base rate score of 60 on any of the clinical syndromes, showing no manifestations of psychopathology. Additionally, the vulnerable group scored lower than the psychologically adjusted group on optimism, life satisfaction, and positive affect, but higher on negative affect.

CONCLUSIONS

The results suggest that personality traits could affect the psychological adjustment of breast cancer survivors. We discuss the implications of belonging to each group and highlight the importance of early identification of vulnerable women in order to facilitate clinical and psychological support.

Assessment of Pain, Acceptance of Illness, Adjustment to Life, and Strategies of Coping with Illness among Patients with Gastric Cancer

Gastric cancer is the fourth leading cause of deaths in Poland. The standard treatment for non-advanced gastric cancer is surgery, which significantly reduces the quality of life of patients. The objective of the study was to evaluate the strategy of coping with pain and its control, acceptance of illness, and adjustment to living with cancer in patients suffering from gastric cancer. The analysis of the impact of socio-economic factors on the above-mentioned problems was also analyzed. The study was conducted among 93 patients diagnosed with gastric cancer, treated on an outpatient basis at the Oncology Center-Maria Skłodowska-Curie Institute in Warsaw in 2017-2018. The PAPI (paper and pencil interview) technique was used. The questionnaire interview included metric questions (socio-economic variables) and four psychometric tests: BPCQ (the Beliefs about Pain Control Questionnaire), CSQ (the Pain Coping Strategies Questionnaire), AIS (Acceptance of Illness Scale), and Mini-MAC (Mental Adjustment to Cancer) test. In the area of pain control, patients with gastric cancer assign the greatest role to internal factors (M = 16.34, SD = 4.93), although women obtained the highest value in the impact of physicians. In the area of coping with pain, patients most likely select the strategy of praying/hoping (M = 22.19, SD = 9.36). The mean value of acceptance of illness for patients with gastric cancer is M = 24.02, SD = 7.69, and it is not conditioned by any socio-economic variable. In the area of mental adjustment to illness, the highest values were obtained by positive reevaluation (M = 20.73, SD = 3.35) and fighting spirit (M = 20.68, SD = 3.98). Patients with gastric cancer control pain mainly through internal factors. The most frequently chosen strategy for coping with pain is praying/hoping, and positive reevaluation prevails in the field of mental adjustment. The results point to specific factors that can affect the patient's pain, quality of life, and treatment outcomes. Knowing the diversity of these factors, it is possible to plan specific psychotherapeutic activities for specific groups of people that could be a supplement to the standard treatment process.

Beneficios de un programa grupal de tratamiento no farmacológico en el afrontamiento del cáncer en mujeres españolas. Una síntesis cualitativa

Resumen En el presente trabajo se analizan los beneficios de un programa grupal de tratamiento no farmacológico realizado por la Asociación Española contra el Cáncer en Galicia (España). Se analizaron 14 ediciones del programa en las que participaron 361 mujeres con cáncer de edades comprendidas entre los 33 y los 82 años. Se adoptó un diseño descriptivo de carácter etnográfico triangulando las técnicas de análisis y las fuentes de recogida de datos por medio de un cuestionario de satisfacción, 32 entrevistas en profundidad y un grupo de discusión con profesionales. Los resultados apoyan la idea de que el programa grupal analizado ha conseguido un elevado grado de satisfacción entre las mujeres participantes en todas las ediciones, ha favorecido la aceptación y el afrontamiento positivo de la enfermedad, aumentado los conocimientos y las habilidades para resolver los problemas relacionados con el proceso, así como promovido las relaciones sociales, la participación en la comunidad y el apoyo social. Desde el punto de vista práctico y profesional, nuestro estudio evidencia la importancia de diseñar e implementar programas grupales desde el ámbito psicosocial y con carácter interdisciplinar que permitan mejorar las estrategias de afrontamiento y el apoyo en poblaciones de mujeres diagnosticadas de cáncer.

Factors Related to Linguistic Content in Video Narrative of Adolescents with Cancer and Healthy Controls

A long history exists of the utilization of narratives to help young people cope with stress and illness. Research is beginning to focus on video based story-telling for the purpose of intervention, however little research has been conducted to look at factors that influence the narrative content of these films. As a pilot, and within the context of a larger study, the current research was conducted with n = 10 adolescents with cancer and n = 10 healthy peers exploring participant characteristics (e.g. personality, quality of life, etc.) and their relationship with linguistic consent of the film. Despite little to no differences identified in demographic characteristics, results identified distinct differences between each group, suggesting that linguistic aspects of film narratives differ in adolescents with and without cancer. This research can serve to motivate future directions of exploration surrounding the content of film narratives and their relationship to patient well-being.

Differences of psychological features in patients with heart failure with regard to gender and aetiology - Results of a CAPS-LOCK-HF (Complex Assessment of Psychological Status Located in Heart Failure) study

OBJECTIVE

Objective of the study was to assess the psychological state of HF patients with reduced ejection fraction (HFrEF) with regard to gender and aetiology.

METHODS

758 patients with HFrEF (mean age - 64±11years, men - 79%, NYHA class III-IV - 40%, ischemic aetiology - 61%) in a prospective Polish multicenter Caps-Lock-HF study. Scores on five different self-report inventories: CISS, MHLC, GSES, BDI and modified Mini-MAC were compared between the sexes taking into account the aetiology of HFrEF.

RESULTS

There were differences in the CISS and BDI score between the genders - women had higher CISS (emotion- and avoidance-oriented) and BDI (general score - 14.2±8.7 vs 12.3±8.6, P<0.05; subscale - somatic score - 7.3±3.7 vs 6.1±3.7, P<0.05). In the ischemic subpopulation, women had higher BDI (general and subscales) than men. In the non-ischemic subpopulation the differences between genders were limited to CISS scale. In a multivariable analysis with demographic and clinical data female sex, NYHA class, atrial fibrillation and diabetes mellitus determined BDI score. Similarly, in the ischemic subpopulation, the female sex, NYHA class and atrial fibrillation determined the BDI, while in the non-ischemic population NYHA class was the only factor that influenced the BDI score. Adding the psychological data made a significant additional contribution to the prediction of depression status.

CONCLUSIONS

There are distinct differences in psychological features with regard to gender in patients with HFrEF. Women demonstrate less favourable psychological characteristics. Gender-related differences in BDI score are especially explicit in patients with ischemic aetiology of HF. The BDI score is related to psychological predisposition.

Temperament and character and quality of life in lung cancer patients

Aim

The aim of this study was to test whether personality variables are independently associated with health-related quality of life (HRQOL) in lung cancer patients.

Methods

In a cross-sectional study, 86 non-small cell lung cancer patients and 73 healthy subjects matched for gender and age were assessed with the Temperament and Character Inventory. In the patient group QOL was assessed with EORTC QLQ-C30. We used multiple linear regressions to determine whether personality dimensions predict HRQOL. Data on tumor stage, patient age, education and marital status were also collected.

Results

Lung cancer patients differed from healthy controls in the temperament dimension of persistence and the character dimension of self-transcendence. The temperament dimension of harm avoidance and the character dimension of cooperativeness were significant predictors of QOL functional scales and global health status.

Conclusions

In lung cancer patients, the personality dimensions of harm avoidance and cooperativeness showed associations with most QOL dimensions. Personality factors are relevant for patients' QOL perception and should be included in cancer patients' QOL assessment.

Propiedades psicométricas del cuestionario de afrontamiento al estrés para pacientes oncológicos (CAEPO)

Los objetivos del estudio fueron: 1) analizar la estructura factorial de la escala CAEPO mediante análisis factorial exploratorio y confirmatorio; 2) estimar la consistencia interna de los factores; 3) describir la distribución de los factores; 4) analizar las diferencias de medias de las estrategias de afrontamiento entre hombres y mujeres. El Cuestionario de Afrontamiento al Estrés para Pacientes Oncológicos (CAEPO) de González (2004) fue aplicado a 148 pacientes oncológicos. Se sugiere reducir la escala a 35 ítems. Se encontró una estructura de cuatro factores correlacionados con consistencias internas de adecuadas a altas. La distribución de los factores se ajustó a una curva normal y no se encontraron diferencias significativas entre hombre y mujeres. En futuras investigaciones, se sugiere su empleo en muestras clínicas de España y otros países hispanoparlantes.